ABSTRACT
OBJECTIVE: To investigate the relationship between umbilical vein catheter (UVC) placement and death in extremely premature newborns (<29 weeks gestation). STUDY DESIGN: Utilizing a retrospective, case-control study design, results for newborns that received UVC placements and died were compared with those who received UVC placements and survived (nâ=â719) by univariate and multiple logistic regression analyses. RESULT: Death rate was 30% in infants with low lines versus 16% in those without (pâ=â0.012). High UVC tip placement significantly and independently increased severe periventricular hemorrhages (pâ=â0.014). Severe periventricular hemorrhage increased death rates by 3-fold independent of gestational age (pâ< â0.001). Proper line placement significantly reduced severe periventricular hemorrhage by 2.5-fold independent of gestational age (pâ=â0.019). CONCLUSION: In extremely premature newborns, incorrect UVC placement is significantly associated with death through its relation to severe periventricular hemorrhage.
Subject(s)
Catheter-Related Infections/mortality , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Infant, Extremely Premature , Intensive Care, Neonatal , Sepsis/mortality , Umbilical Veins , Catheter-Related Infections/etiology , Catheterization, Central Venous/methods , Catheterization, Central Venous/mortality , Catheterization, Peripheral/methods , Catheterization, Peripheral/mortality , Clinical Competence , Female , Guideline Adherence , Humans , Infant, Newborn , Male , Pregnancy , Retrospective Studies , Risk Assessment , Sepsis/etiologySubject(s)
Anti-Bacterial Agents/administration & dosage , Catheterization, Central Venous/instrumentation , Catheterization, Peripheral/instrumentation , Catheters, Indwelling , Central Venous Catheters , Meningitis, Pneumococcal/drug therapy , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Device Removal , Equipment Design , Equipment Failure , Humans , Infant , Infusions, Intravenous , Male , Meningitis, Pneumococcal/diagnosis , Meningitis, Pneumococcal/microbiologyABSTRACT
OBJECTIVE: Investigate the benefit of umbilical catheterization upon survival and selected morbidities in extremely premature newborns (<28 weeks gestation). Outcomes of successfully catheterized extremely premature newborns are compared with others who cannot be successfully catheterized, and we hypothesize that umbilical catheterization promotes survival and reduces morbidities. STUDY DESIGN: Utilizing a retrospective, cohort study design, survival and outcomes of catheterized and non-catheterized newborns (n = 722) were compared by univariate and multiple logistic regression analyses. RESULTS: Of all newborns, 66.8% had both umbilical arterial catheter (UAC) and umbilical venous catheter (UVC) placements, 15.0% had only UAC, 13.7% had only UVC, and 4.6% had neither. Overall survival was 82.5%. Survivals with and without UAC were 82.5% and 82.6% (NS), but survival with UVC was 80.7% versus 90.1% without UVC (p = 0.012). Analysis of risk factors associated with death during umbilical catheterization reaffirmed that death remained significantly dependent upon UVC placement (OR = 35.7; 95% CI: 3.7-347.3, p = 0.002). CONCLUSION: Successful umbilical catheterization of extremely premature newborns does not provide benefit through promotion of survival or reduction of morbidities when compared to others who are not successfully catheterized at the umbilicus.
